Abdominal sacral colpopexy

LEFRANC JP | LAURATET B | FOURNET S | BENHAIM Y | NGUYEN T

Seance of wednesday 23 november 2005 (CHIRURGIE GYNECOLOGIQUE : PRISE EN CHARGE DES PROLAPSUS GENITAUX)

Abstract

Abdominal sacral colpopexy has shown for many years its efficacyin the treatment of genital prolapse. By using synthetic mesh itallows very durable results with a very low rate of complicationseven in terms of erosion and infection of grafts. Two limits to thetechnique can nonetheless be noted. Anteriorly, the prosthetic reinforcementof the endopelvic fascia is limited by the presence of thetrigone, so, the sacrocolpopexy must be completed by a colpopexywith para vaginal repair to provide complete treatment of the cystocele.Posteriorly, there is no anatomic limit but it is almost impossibleto do a complete reinforcement of the recto vaginal fascia byusing the abdominal approach. It is at this level that the techniquecould be improved to allow a reinforcement of the fascia up to theperineal body. Two solutions seem possible: a combined abdominal-vaginal procedure with first dissection of the recto vaginalspace through the perineum or laparoscopy that seems today to bethe way of the future.